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DETERMINATION OF COST OF ILLNESS

DETERMINATION OF COST OF ILLNESS. Direct costs Indirect costs Intangible costs. Direct Costs. Outpatients costs Physician and Health professional Radiographs MRI, CT scans Endoscopies Other tests Drug Costs DMARDs Biologics NSAIDs GI medications and Analgesics

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DETERMINATION OF COST OF ILLNESS

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  1. DETERMINATION OF COSTOF ILLNESS • Direct costs • Indirect costs • Intangible costs

  2. Direct Costs • Outpatients costs • Physician and Health professional • Radiographs • MRI, CT scans • Endoscopies • Other tests • Drug Costs • DMARDs • Biologics • NSAIDs • GI medications and Analgesics • Hospitalisation costs

  3. INDIRECT COSTS • Loss of income from work • Work disability in 60 - 70% after 5 years • RA more likely to lose jobs or retire early than OA • Reduction in household income • 15% unable to get work • 3 - 4 x higher than direct costs • Underestimated because of predominance of women

  4. INTANGIBLE COSTS • PAIN • PSYCHOLOGICAL Depression, Coping, Anxiety, Cognitive changes • LIMITED ACTIVITIES • CHANGE IN APPEARANCE

  5. ARTHRITIS IMPACT SURVEY(KEH, Durban) • 35% Totally dependent on state support • Pensioners 10% • Disability grant 25% • Two thirds of patients who stopped working did so because of their arthritis

  6. Disability Legislation In 1990 President Bush signed into law the Americans with Disabilities Act to extend the application of civil rights legislation to persons denied access to employment, housing, education, transportation or leisure pursuits due to chronic diseases

  7. Factors influencing work disability in RA • Employment factors • Nature of job, physical activity needed, degree of autonomy, work environment, transport to work • Employee factors • Age at onset of RA, marital status, education, motivation for work • Disease factors • Time since onset, level of disability, EMS, flare-ups • Other factors • Visits to GP, hospital clinic, surgery, rehabilitation

  8. Vocational Rehabilitation A process whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment, or other useful occupation

  9. Vocational Rehabilitation • The best way to maintain work is to communicate quickly with employer at disease flare-up • Encourage openness between patient and employer • Current employer more likely to facilitate continued working than a new employer • Return on costs between 2 – 10 fold

  10. Remedies • Referral to Work Assessment Unit • Health service ready to respond to worker’s urgent need • Physician assessment of the risk of job loss • Job modification • Transport • Self-employment • Intensive rehabilitation

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